When Rita tried to claim on her insurance when her dog became sick, her insurer rejected the claim, saying that it was a pre-existing condition. So she asked us to look at the case.

Customer doesn’t disclose pet’s pre-existing medical condition

When Rita tried to claim on her insurance when her dog became sick, her insurer rejected the claim, saying that it was a pre-existing condition. So she asked us to look at the case.

What happened

Rita made a claim on her policy for treatment costs after her dog, Bella, had a bout of sickness. But her insurer declined the claim.

Her insurer had noted that her dog had suffered with several bouts of sickness before the policy started. Rita said the previous episodes were unrelated and had been treated before the policy began, so were unconnected to this claim.

How we helped

We looked at the vet’s notes, and we thought it was clear that there was no connection to the pet’s sickness episodes. So we didn’t agree that the illness was pre-existing. However, the insurer said that if they’d known about the Bella’s previous sickness episodes when the policy was taken out, they would have added an exclusion for digestive problems.

The insurer also gave us a copy of the online application. We found that it clearly asked about the pet’s history and Rita could have disclosed Bella’s past problems with sickness. The insurer’s underwriting guidance confirmed that if they had been aware of the earlier sickness, they would have added the exclusion to the policy.

Putting things right

We agreed that the condition wasn’t pre-existing, so the claim shouldn’t have been refused on that basis.

However, we didn’t uphold the complaint. Had Rita disclosed the earlier sickness when she took out the policy, an exclusion would have been added which would have applied to this condition. So we said it was fair for the insurer to add that exclusion and decline the claim.